2010 TBI Inventory – Part 2


Persistent Intellectual Impairments
Check Score Note
Memory problems No 0 Excellent memory. Recall critical to work
Difficulty concentrating No 0 No such difficulty
Attention Difficulties No 0 No such difficulty
Easily Distracted No 0 No such difficulty
Misplacing or difficulty tracking things No 0 Able to act without memory aids
Difficulty making decisions No 0 Rational decision making. Self directed investor
Difficulty solving problems No 0 Work centred on constant problem solving
Difficulty understanding spoken instructions No 0 Work was verbal. Excellent performance
Difficulty understanding written instructions No 0 Many written policies. Followed 100%
Difficulty finding words No 0 Not experienced
Difficulty communicating thoughts / feelings Yes 1 Discussions with Dr D. See End Note.
Unintentionally repeating the same remarks No 0 Not noted
Unintentionally repeating same activities No 0 Not noted
Stuttering or stammering No 0 Not observed
Difficulties doing simple math No 0 Managed own investments
Impaired abstraction or literalness No 0 Not Observed
Mental rigidity No 0 Job required flexibility
Deficits in processing information No 0 Work mandated handling large volumes of information
Deficits in sequencing information ?? Still not sure what this means
Difficulty executing or doing things No 0 Projects completed on time and budget
Difficulty starting or initiating things No 0 Many household and work projects
Difficulty handling work requirements No 0 Excellent work performance
Difficulty handling school requirements No 0 Job required continual learning
Having to check and re-check what you do No 0 Job required high accuracy, performance highly monitored
Disoriented by slight changes in daily routine No 0 Accommodated all change including major shift changes at short notice
Unsure about things that you know well No 0 Confident in my abilities and performance
Difficulty learning new things No 0 Continual learning a key aspect of job
Doing things slowly to insure correctness No 0 Job required immediate delivery of correct results
Decreased capacity for reality testing ?? 0 Still not sure what this means
Impaired ability to appreciate details No 0 Attention to detail critical to job
Impaired ability to benefit from experience No 0 Continual learning from experience
Inappropriate responses to people & things No 0 Was grounds for immediate termination
Difficulty taking care of your self No 0 Not observed
Difficulty taking care of children No 0 Assisted Colin
Section 1 Totals: 1
Psychological Consequences Check Score Note
Impaired sense of self No 0
Fear of loss of control Yes 1 Associated with 2007 panic attacks
Easily agitated or irritated No 0 Had to control to perform job
Easily startled No 0 Not noted.
Feelings of paranoia No 0 Not observed
Spells of terror or panic Yes 3 Sought therapy with Dr D. See End Note.
Feelings of depression No 0 Not observed
Feelings of shame or guilt No 0 Not observed
Persistent anxiety Yes 2 Associated with 2007 panic attacks.
Anxiousness or feelings of fear and dread No 0 Not observed
Feelings of discouragement No 0 Nothing beyond routine.
Withdrawal or social isolation Yes 2 Consequence of crazy work schedule and employer demands
Feeling others not appreciating your difficulties No 0 Not observed
Feeling everything is an effort No 0 Sense of job mastery
Feeling inept or worthless No 0 Extremely positive performance feedback.
Laughing or crying without apparent cause No 0 Not experienced
Worrisome thoughts won’t leave your mind No 0 Not experienced
Making up explanations for things No 0 Not experienced
Insensitive to others and social context No 0 Would have resulted in poor job performance
Diminished insight No 0 Coached other agents job performance. Required insight.
Section 2 Totals: 8
Persistent Mood Disorders Check Score Note
Mood swings No 0 Extremely stable and consistent.
Having urges to beat, injure or harm someone No 0 Never
Shouting or throwing things No 0 Never. Would not have been tolerated in work place.
Temper outbursts that you could not control No 0 No temper and no outbursts. Would not have been tolerated in work place.
Section 3 Totals: 0
Persistent Physiological Impairments Check Score Note
Heart pounding or racing No 0 Never. Undertook regular excercise to compensate for sedentary occupation.
Rapid pulse No 0 Very slow and stable pulse.
Headaches or head pains No 0 Never
Increased blood pressure No 0 Never
Increased sensitivity to touch No 0 Not experienced
Ringing in ears No 0 Never
Easily fatigued No 0 Not experienced
Numbness or tingling in parts of your body No 0 Not experienced
Weakness or loss of strength No 0 Not noted. Did home renovations, shovelled snow with no problems.
Feeling tense or keyed up No 0 High stress job but managed it well.
Restlessness, unable to sit still No 0 Sitting mandatory for job performance
Lessened ability to perform physically No 0 No noted problems
Decreased tolerance for alcohol and drugs No 0 Do not use
Appetite disturbances No 0 Strong, consistent appetite
Trouble falling asleep No 0 Excellent sleep hygiene
Awakening during the night No 0 Worked nights. Rarely woke during the day apart from noise disturbance.
Sleep that is restless or disturbed No 0 Slept well, woke refreshed
Section 4 Totals: 0
Persistent Personality Alterations Check Score Note
Passivity, or submissiveness No 0 Not experienced
Aggressiveness No 0 Would not be tolerated in the workplace.
Apathy, lack of interest or emotion No 0 Grounds for dismissal.
Overly sensitive No 0 Agents had to accommodate all kinds of customers.
Discouragement or demoralization No 0 Not experienced
Increased emotional distress No 0 Not in workplace
Chronic frustration No 0 Experienced satisfaction at performing in a difficult environment.
Grandiosity or boastfulness No 0 Not experienced
Excessively talkative No 0 Not experienced
Compulsive writing No 0 Not experienced
Egocentricity No 0 Not experienced
Childishness No 0 Not tolerated in the workplace
Silliness No 0 Not tolerated in the workplace
Overly responsible No 0 Adhered to my area of responsibility.
Irresponsibility No 0 Not tolerated in the workplace.
Impulsively No 0 Not tolerated in the workplace.
Self-indulgent No 0 Not experienced
Indiscreet comments and acts No 0 Not tolerated in the workplace.
Obscene comments or acts No 0 Not tolerated in the workplace.
Increased sexual activity No 0 Not experienced
Decreased sexual activity No 0 Not experienced
Increased shame or guilt No 0 Not experienced
Religiosity No 0 Not experienced
Section 5 Totals: 0
Persistent Neurological Problems Check Score Note
Sense of observing your self from afar No 0 Not experienced
Altered consciousness No 0 Not tolerated in the workplace.
Slowed reaction time No 0 Reaction time measured in the workplace and was key retention metric.
Smelling odors that others do not smell No 0 Not experienced
Hearing music that others do not hear No 0 Not experienced
Making up explanations for things No 0 Not tolerated in the workplace.
Sensitivity to temperature shifts No 0 Not experienced
Seeing dark spots before your eyes No 0 Not experienced
Blurred vision, especially when fatigued No 0 Not experienced
Double vision especially when fatigued No 0 Not experienced
Diminished night vision No 0 Not experienced
Difficulty relaxing No 0 Not experienced
Twitching No 0 Not experienced
Sensitivity to sound or noise No 0 Not experienced
Sensitivity to light No 0 Not experienced
Section 6 Totals: 0

End Notes

The issues identified were acute in nature, were primarily evident during therapy sessions, and did not extend over the complete period prior to the accident of March 06th 2011. They were absent during the 2009, 2010, January to March 2011 period.

In the fall of 2007 I experienced crippling anxiety attacks while at work. These were precipitated by a fear of loss of employment arising from a work place rumour. I did not know anything of anxiety attacks and did not identify them as such.  I thought these events were signs of some pending mental illness and I sought therapy with Dr. D.

In the course of our therapy sessions, I experienced considerable difficulty addressing specific events from my past. Discussion of these events would trigger a high level of anxiety.  At some time in 2010 my employer altered my shift schedule to place me on an overnight shift. This made it very difficult to continue seeing Dr. D. I was secretly glad of this change as I wished to avoid encountering all of the problems experienced in therapy sessions.

Subsequent to the accident, I find I experience no anxiety despite having failed to locate employment and living on dwindling retirement savings. I find this to be very strange given that my initial reason for consulting Dr. D was due to anxiety attacks provoked by a work place rumour of job loss. This job loss is no longer rumour but is now fact; I am unable to explain my lack of anxiety in response to my current situation. This lack of anxiety was one of three key triggers that caused me to seek medical attention.

 

 

 

 

2010 TBI Inventory – Part 1

In conducting a review of the September 2012 and September 2013 TBI inventory data, I have found myself becoming very frustrated. Some of the terms are not understood by me, the response requires self-reporting, and I do not count myself as a reliable witness.

This morning I had the realization that for 12 years I worked in an environment recognized to be among the most stressful of workplaces. All call centre operations are closely monitored and employee performance is constantly checked. Every agent action is subject to scrutiny, all events are timed, each customer interaction is recorded. This recording includes screen grabs of the agent’s computer desktop in addition to a voice recording of all customer interaction. When I worked as a call centre QA assessor, I was able to pull up the agent’s entire record of past calls to determine when a performance deficit had commenced.

In addition to Quality Assurance monitoring of each agent’s work, the call centre technical support staff were required to spend two hours each day monitoring and scoring random agent calls. Each call centre manager was also required to spend two hours each day listening to the work of those agents under his / her supervision.

Each customer was requested to score his / her satisfaction with the agent’s performance at the end of the call. An outside 3rd party was employed to conduct random telephone surveys of recent customers and obtain a detailed response in regard to their satisfaction with call centre agent performance. The outcomes of these various surveys were reviewed with each agent on a regular basis.

Most employees found this work environment extremely stressful. If you were unable to deliver the expected standard of performance, you were subject to dismissal. The agent had no ability to control customer behaviour, or attitude, and was expected to respond in a polite manner to customer hostility and belligerence.

The agent had to accept any request placed by the customer. It did not matter if the issue fell outside the agent’s scope of responsibility, product knowledge, or skills training. I worked for the same global enterprise for over 12 years and, at the end of this time, I was still fielding calls in regard to products, and company operating units, that I had no idea even existed. I was required to handle the caller’s request in a manner satisfactory to the caller even when I had no understanding of the topic raised by the customer.

The IT industry is known for constant, rapid change. Over the course of 12 years with the same firm, I changed physical location more than 8 times. Each move meant a different physical location, often a different province. This movement does not reflect all of the regular internal changes in seating arrangements, in managers, colleagues, contacts, policies, hardware, desktop tools and interfaces. I handled all of these manifold changes without complaint, or problem.

I have encountered case studies in both the management literature, and in occupational psychology, which address call centre employment and describe it as the full realization of Bentham’s Panopticon. A consistent high level of employee stress arises due to the ongoing observation and micro-management of every aspect of employee behaviour and work performance. And within this environment, I delivered performance unequalled by any in my work group.

I have worked in a wide variety of occupational settings. These include the Federal government, the marine industry, creative industry (film), the engineering industry, and the oil industry. I also performed small business consultancy work while in Nova Scotia. In all this experience I have never encountered another work environment that is subject to such extreme constraints on employee task performance, to such narrowly defined productivity and performance requirements, or a workplace subject to such exhaustive monitoring and continual micro management. Yet I performed superlatively in this environment (largely because I did not care about the external monitoring; I was my own harshest critic and taskmaster).

I believe that any survey of the extant scientific literature on workplace environments would support the above description. I know that when I started employment in the call centre it was understood that call centre employment was one of the few occupations that would not result in a refusal of unemployment benefits if the employee were to quit. Even the Federal government recognized the difficult demands of the call centre work place.

In view of the above, I have undertaken to re-score the September 2012 TBI inventory. The scores are based on my memory of my behaviours during a period of employment which commenced in November 1999 and continued until the accident of March 06th 2011 without interruption.

I believe this analysis sheds considerable light on the changes which have become manifest since the accident of March 06th 2011.

 

 

 

 

Section 1 Analysis

I recently searched for a post regarding a text entry metric. In the course of that search, I located the TBI Inventory, Section 1 of which is included here. This event is reported in the post  Blogging and Avoidance  together with links to the other sections of the TBI Inventory. Sections 2 to 6 of the Inventory have been reviewed in prior posts. There was no prior post for Section 1. It appeared to have been completely omitted, or lost, or never created.

Then, while opening the WordPress draft of another post, I found a draft version of the Section 1 analysis. The tabular data had been entered and scored but there was no associated discussion, or comment. The original scoring would have been entered at the time of the original draft which WordPress reports as being entered on August 31st 2013. All of my comment was added today, May 19th 2014.

Section 1 Persistent Intellectual Impairments
2012 2013
Unscored 8 0
Scored 0 4 7 Not Present
Scored 1 0 0 Present, no interference
Scored 2 1 3 Mild, not disabling
Scored 3 19 21 Moderate, greatly interferes
Scored 4 0 1 Extremely disabling
Items N/A 2 2
n=34

Section 1 Improvements 2012 2013
Item 1.32 Inappropriate responses to people and things 3 2
Item 1.33 Difficulty taking care of yourself 3 2


Both items in this first section show an improvement between 2012 and 2013. I suspect the 2012 Item 1.32 response is associated with my prior attempts to flee supermarkets due an inability to handle the noise. I now shop in the off hours when I know the store will be quiet.

I experience greater amounts of irritability today than previously. This is relatively new. Since I have training in customer service handling I am able to recognize when I feel an impulse to act out of irritability and I constrain myself.

I have recently been to a dentist. My teeth have sustained much more damage than I was first aware of. They should have been attended to earlier. Part of the reason for not doing so was the belief that I would be covered by the insurance claim. I did not wish to incur significant out of pocket expense while attempting to stretch out my retirement savings.

Section 1 No Change
Item 1.1 Memory problems Score 3
Item 1.2 Difficulty concentrating Score 3
Item 1.3 Attention Difficulties Score 3
Item 1.4 Easily Distracted Score 3
Item 1.5 Misplacing or difficulty tracking things Score 3
Item 1.6 Difficulty making decisions Score 3
Item 1.9 Difficulty understanding written instructions Score 3
Item 1.10 Difficulty finding words Score 3
Item 1.11 Difficulty communicating thoughts & feelings Score 3
Item 1.13 Unintentionally repeating same activities Score 2
Item 1.18 Deficits in processing  information Score 3
Item 1.20 Difficulty executing or doing things Score 3
Item 1.21 Difficulty starting or initiating things Score 3
Item 1.24 Having to check and re-check what you do Score 3
Item 1.25 Disoriented by changes in daily routine Score 3
Item 1.26 Unsure about things that you know well Score 3
Item 1.27 Difficulty learning new things Score 3
Item 1.28 Doing things slowly to insure correctness Score 3


The memory problems continue. See the prior three posts for a description of a recently discovered memory problem. I would today rate this item as a 3.5, or even as a 4.0 due to its potential impact.

Difficulty finding words appears to have improved since 31 August 2013, the date on which I entered the 2013 data. I remember having particular problems with compound words: I would remember the Ernest but not the Hemingway. I still experience this problem but my sense is that it is less of an obstacle than it once was. The work on the blog may take the credit for the improvement.

I feel I am better able to communicate thoughts and feelings. If I read posts from the start of the blog and compare them to recent posts I believe there is a noticeable positive improvement. I believe I have become more self-aware and the blog is a vehicle that has assisted with this progress.

I do tend to repeat the same activities. In a prior post, I postulated that 90% of my activities involve cooking, photography, walking, and blogging. When I become upset I will retreat into these activities. There is less of the repetitive performance of the same action which was noted immediately after the accident.

I continue to have difficulty executing or doing things. I can get things done but I take an inordinate amount of time. I have the hope that the constant application of effort will result in a speed improvement but any such improvement appears to be very slow, if not glacial. I have an entire range of projects and activities that I have not engaged in since the accident and I am now proceeding to throw these things out as it appears very unlikely that I will ever reconnect with them. I am uncomfortable doing new things or extending outside my normal range. I need to constantly recheck what I do and then double check to make sure that I checked; I do not trust myself. I seek to avoid change in my daily routine. Any trip to a new dentist, or other new location, becomes an expedition project. I spent a day planning and preparing for a day trip to Montréal. I become very uncomfortable if I travel on new routes in the city and avoid this if at all possible. I refuse to park in other than my pre-established standard stops. I have 30 years of programming and PC experience, including 12 years in advanced tech support, but get flustered making changes to my own equipment. There are things that need to get fixed but I just defer this due less to complexity than a recognition of my own inadequacies. I have tried to brush up on my html, css3 and js skills. These are relatively simple programming languages  (I used to program in x86 Assembly which is a beast)  but I have difficulty in simply updating my skills. Everything I do is done slowly. If I attempt to operate at normal speed, I either become frustrated to the point I want to throw things, or I make so many errors I may not have bothered to start. In just this post I have made multiple errors and have entirely omitted chunks of text (an error I just found and corrected.)

Section 1 Increases
Item 1.7 Difficulty solving problems From blank to 3
Item 1.8 Difficulty understanding spoken instructions From 0 to 3
Item 1.16 Impaired abstraction or literalness From blank to 3
Item 1.17 Mental Rigidity From blank to 3
Item 1.21 Difficulty handling work requirements From blank to 4


This is awkward as I am tending to re-rate my 2013 responses based on my current response. On Item 1.17 Difficulty solving problems I would today rate that as a 2. I have the ability to solve problems; I am just much slower than I was. I have also come to rely on the fact that if I attempt a problem and am unable to resolve it, that it is likely that my mind will eventually present a full, or partial solution. This was first noted with the quiz puzzles presented by Dr L.

The prior three posts all address  Item 1.18 Difficulty understanding spoken instructions. This may be influenced by my hearing loss since the accident and an inability to discriminate spoken words from background noise. It may also be due to a failure to remember just what was said.

I also believe that I am showing improvement in abstraction. I believe the blogging activity is helping me in handling conceptual problems. Today I would rate this as a 2.5.

Mental rigidity remains a sticking point. In the real world I continue to follow the same set of routines and travel the same routes. With photography I appear to have forgotten my prior routines and this has led to an improvement in image making. With blogging I experience my writing as being more playful. Today I would rate this as 2.5.

I am not sure on what basis I scored Item 1.21 Difficulty handling work requirements. I am fairly certain that were I to attempt to perform my prior work for the computer company, I would have great difficulty in doing so. That job required the ability to multi-task which I no longer have, it required an ability to control frustration and irritation which I now have difficulty with, it required an ability to recall informal data from months previously, a skill I no longer have, it required an ability to engage in constant learning which is something I continue to have trouble with. I would leave this item scored at 4.

Section 1 Not Observed
Item 1.12 Unintentionally repeating the same remarks
Item 1.14 Stuttering or stammering
Item 1.15 Difficulties doing simple math
Item 1.19 Deficits in sequencing information
Item 1.29 Decreased capacity for reality testing
Item 1.30 Impaired ability to appreciate details
Item 1.31 Impaired ability to benefit from experience


On Item 1.15 Difficulties doing simple math, it is noted that the first attempt to total the scores associated with this inventory was attempted manually and it was incorrect. All later scores have been tabulated using built in spreadsheet functions. I use a calculator at all times.

I am not sure I understand what is meant by Item 1.19 Deficits in sequencing information or by Item 1.29 Decreased capacity for reality testing.

I know that I had some problem with speech when I first saw Dr H. I cannot remember where I encountered the note on this. I suspect it was in the Accident Log. Today I would score Item 1.14 as not observed.

Section 1 Not Applicable
Item 1.23 Difficulty handling school requirements
Item 1.34 Difficulty taking care of children


There is no change in the items in this section.